Equine Humerus Fractures: Conservative Treatment Can Be Successful

Horses with fractures restricted to the deltoid tuberosity on the humerus (a bony structure located near the midsection of the humerus, the bone located between the shoulder and elbow joints) can have an excellent prognosis if treated with conservative therapy, according to the results of a recent study completed by Andrew R. Fiske-Jackson, BVSc, MRCVS, a resident in equine surgery at the Royal Veterinary College in the U.K.

Fractures to the deltoid tuberosity (circled) can be successfully healed with conservative treatment.

Humerus fractures are uncommon in horses, notes Fiske-Jackson, as tremendous force is needed to fracture this short, thick bone, and a fracture will result in severe lameness. Generally the cause is a kick or a fall (e.g., on ice), although researchers note that some racehorses suffer stress fractures of the humerusdue to the rigors of racing. Surface wounds typically accompany fractures caused by kicks as the skin will split due to the impact, Fiske-Jackson added.

Upon reviewing the medical records of 19 horses with humerus fractures for their current study, the researchers found that conservative initial treatment using minimal wound debridement (to remove diseased and dead tissue), combined with rest and daily saline flushes, antibiotics, and wound care, was the most successful method in treating humeral fractures.

"Horses that had fractures restricted to the deltoid tuberosity had an excellent prognosis with this treatment," Fiske-Jackson said. "But the extent of the fracture must be verified prior to going ahead with conservative treatment.

"Occasionally horses will need to be taken to surgery to have the fracture plated under general anesthesia," he cautioned. "These will be fractures that involve the portion of the humerus adjacent to the shoulder joint, and such fractures carry a poor prognosis."

The alternative treatment method is more risky (as the horses must be anesthetized and undergo surgery) and carries a heftier price tag for the owner than the conservative approach.

In Fiske-Jackson's study, the horses remained at the hospital until the veterinarian deemed them fit to travel home. Length of stay ranged from one to 19 days, with the average being seven days.

He noted that following hospital discharge, lameness in these conservatively treated horses should begin to improve over 48 hours. If improvement isn't noted the owner should contact the veterinarian, as most of these horses will recover quickly to their former level of exercise and work; in this study, for example, 13 of the 14 horses available for follow-up assessment had returned to athletic function and soundness. Fiske-Jackson said total recovery time averages about seven weeks for these types of fractures.

The study, "Diagnosis, management, and outcome in 19 horses with deltoid tuberosity fractures," was published in the December 2010 issue of Veterinary Surgery. The abstract is available on PubMed.

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